Organization
PRIMARY CARE PLUS, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. VENKATESH MADHAV M.D. (PHYSICIAN/OWNER)
(615) 443-1579
Entity
Organization
Contact information
Practice address
1405 W BADDOUR PKWY, SUITE 103, LEBANON, TN 37087-2567
(615) 443-1579
(615) 443-1580
Mailing address
10211 AUBURN PARK DR, FORT WAYNE, IN 46825-2387
(260) 490-8187
(260) 490-3123
Taxonomy
Speciality
Code
Description
License number
State
207RG0300X
Geriatric Medicine (Internal Medicine) Physician
Primary
L2436
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1515562
—
TN
Enumeration date
05/21/2009
Last updated
12/22/2009
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